Journal of Reconstructive Urology

.: ORIGINAL RESEARCH
Management of Lower Urinary Tract Injuries
Alt Üriner Sistem Yaralanmalarının Tedavisi
Ahmet ARIMANa, Erkan MERDERa
aOkmeydanı Training and Research Hospital, Clinic of Urology, İstanbul, TURKEY
J Reconstr Urol. 2020;10(1):17-22
doi: 10.5336/urology.2020-74707
Article Language: EN
Full Text
ABSTRACT
 Objective:To compare immediate realignment of the urethra plus a suprapubic cystostomy approach with only suprapubic cystostomy followed by later reconstruction in urethral injuries. Material and Methods: Twenty male patients with lower urinary tract injuries due to external trauma were included in the study. Seventeen patients had urethral, 2 of patients had both urethral and bladder and 1 patient had only bladder injury. There were 4 anterior, 15 posterior urethral injuries, the majority of these being complete urethral ruptures. The results in 14 patients who had immediate realignment of the urethral injury by an urethral catheter plus suprapubic cystostomy (Group 1), compared with 5 patients who had only immediate suprapubic cystostomy (Group 2). Patients with bladder perforation were treated immediately by open operation. Results: During follow up of 2 year period %60 of patients in the first group and %25 of patients in the second group had urethral stricture respectively. Six patients in the first group and 1 patient in the second group required urethroplasty in the follow up period. Urinary incontinence and erectile dysfunction were more common in the first group. Conclusion: Suprapubic cystostomy and if necessary delayed urethroplasty approach has better results than immediate realignment approach in the urethral injury.

Keywords: Urinary bladder; urethral stricture; urethra
ÖZET
 Amaç: Üretra yaralanmalarında, üretranın erken uç uca yaklaştırılması ve birlikte suprapubik sistostomi uygulanan olgular ile ilk müdahale olarak yanlızca suprapubik sistostomi uygulanan ve daha sonra gerekirse uretral rekonstriksiyon uygulanan olguları karşılaştırmak. Gereç ve Yöntemler: Eksternal travma nedeniyle alt üriner sistem yaralanmalı 20 erkek hasta çalışmamıza alındı. On yedi hastamızda üretral, 2 hastamızda hem üretral hem de mesane, 1 hastamızda ise yalnızca mesane yaralanması vardı. Üretra yaralanmaları 4 hastamızda anterior, 15 hastamızda ise posterior üretradaydı. Ve bunların çoğu komplet üretral rüptürdü. Suprapubik sistostomi ile bereber bir üretral kateter vasıtasıyla üretra rüpturü uç uca erken yaklaştırılan 14 hasta (Grup 1) ile yanlızca erken suprapubik sistostomi uygulanan 5 hastanın (Grup 2) sonuçları karşılaştırıldı. Mesane perforasyonu olan hasta ise acil olarak açık operasyon ile tedavi edildi. Bulgular: İki yıllık takip sürecinde ilk gruptaki hastaların %60'ında ve ikinci gruptaki hastaların %25'inde üretral darlık gözlendi. Bu takip sürecinin sonunda birinci gruptaki 6 hasta ve ikinci gruptaki 1 hastaya uretroplasti gerekti. Üriner inkontinans ve erektil disfonksiyon birinci gruptaki hastalarda daha sık oranda görüldü. Sonuç: Çalışmamız sonucunda, üretra yaralanmalarında ilk aşamada suprapubik sistostomi ve gerkirse daha sonra üretroplasti uygulanmasının erken üretra yaklaştırma tekniğinden daha iyi sonuç verdiği kanaatindeyiz.

Anahtar Kelimeler: Mesane; üretra darlığı; üretra
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